The Mature Minor Doctrine: A Case Analysis

The ethical issues involved in this topic include age limits, medical ethics, informed consent, and autonomy. It is unethical and immoral to allow adolescents to make their own medical decisions, because the judgment and capacity to make coherent decisions is unstable. However, adolescents should be involved and have a voice in the process of decision making, nonetheless I believe that the concluding medical decision should be made by the guardian and the doctor. An adolescent is between the ages of thirteen and nineteen. Society permits the legal determination of decision making for health care at the age of eighteen years. It is very important to consider developmental issues which will influence both reasoning and information processing, the brain not being fully developed causes a sense of a lost identity, and low self esteem challenges adolescents to develop a logical decision. An adolescent brain is not yet fully developed, the lack of grey matter and an

This memorandum is written to inform others on the topic of mature minors and medical decisions. This matter has come to the surface of major debate and concern recently. One specific court case, involving Cassandra Callender of Windsor Locks, Connecticut, has sparked much of that concern. Seventeen-year old Cassandra was diagnosed with stage-three Hodgkin's Lymphoma and told by several doctors that she would predictably die within two years without the rounds of chemotherapy they had recommended for her. With the treatment, there was an expected 85% chance of survival (Cassandra Callender). However, Cassandra’s mother kept switching her daughter’s doctors, constantly questioned the diagnosis they were making, and according to the commissioner of her case, had, “...failed to meet the medical needs’, of Cassandra”. Cassandra was taken from her home and placed in her cousin’s because of her mother’s medical neglect. Callender’s mother testified that she knew that her daughter had cancer and that it was something that needed to be taken seriously. She further testified that her daughter should begin the chemotherapy rounds as quick as possible. Medics came to Cassandra’s home, after being returned

In the case of a minor unable to consent or make decisions (due to a mental condition or conscious state) and the absence of parents or legal guardians, two medical doctor must make all medical decisions on his behalf including cardio pulmonary resuscitation and termination of life support.

alcohol to minors and public possession of alcohol by minors. Since the passage in 1984 of the

If an emergency is life-threatening, or the patient is not mentally competent to make a decision regarding consent, then the requirement may be waived. In a life-threatening situation, there may not be time to provide a patient with the risks and benefits of a procedure. If a surrogate is available to make a decision on behalf of the patient, such as a spouse or a parent, then they will often to be authorized to give consent. Otherwise, informed consent is presumed.

Patient informed consent refers to the situation where the patient is fully informed on the consequences of their health care decision after which the patient gives the decision. For there to be informed consent, there are five elements that must be discussed. The first is the nature of the patient's decision then the applicable alternatives to the proposed intervention. Third are the risks, benefits and uncertainties associated with each of the alternatives. Fourth is the assessment of the patient's understanding and last is the acceptance of the intervention or an alternative by the patient. Before the patient's consent is considered to be valid, the patient's competency to make the decision must be addressed. The criteria for evaluating the patient's competency is clearly stated in section 3 of the 2005 Mental Capacity Act which states that provided the person is able to understand, retain and use information provided and to communicate their decision in any way such as talking or sign language, they are competent to make a decision. If a patient is treated against their refusal to consent, it amounts to the tort of battery or can also be considered the crime of assault. In addition to this, laws that touch on human rights reinforce the importance of the protection of the physical integrity of the individual in terms of their right to respect of their private life. Therefore, refusal of medical treatment is a human right.

Consent for medical treatment is based on three legal ideals: the patient must be informed to make a decision, the patient cannot be intimidated into making a decision, and the patient must be competent (McCabe). In 1982, a study was held by Weithorn and Campbell showing the competency of four age groups (9,14,18, and 21 years-old) based on questions from the ideals aforementioned. The study concluded that fourteen year-olds’ competence and adult are analogous, while nine year-olds could partake in discussions based off of their treatment (Weithorn). The study conducted by Weithorn and Campbell, not only displays competence, but also the ability to comprehend the possible outcomes, and determine the importance of these possible outcomes relative to their own lives. With studies showing that at the age of fourteen the decisional capacity (prefrontal cortex) of the human brain is equal to that of an eighteen year-old, the legal age of consent must be lowered to fourteen years of age.

Some legal considerations are the Principles of Informed Consent. What this principle imposes is it allows a competent individual to advance his or her own welfare. This right and responsibility is

However, in order to best communicate informed consent, counselor can educate their students through school handbooks, brochures, classroom curriculum, and informing students verbally (p. 2). Confidentially looks different in terms of working with minors, when assessing a situation for serious and foreseeable harm. A counselor must consider students’ chronological and developmental age. As well as the setting, parental rights, and the nature of harm possible. Additionally, school counselors need to consider students’ ethical rights to make their own choices, and to give assent or consent, and the legal rights of the students’ parents and families to make choices for their child (p. 2).

As per Beal & Lewis, 2014 Informed consent is a process of education and the correct education is a key to the ability to provide consent.

Healthcare Consent legislation applies to everyone above the age of 18 (some places 16) and has the following rights (Ref 1)

The healthcare team will observe the legal statutes of the state of California when administering care to minor patients. Minor patients are any patients under the age of 18 at the time that services are rendered. In the state of California, minors of any age may consent to medical care related to pregnancy, contraception, abortion, emergency medical service, sexual assault and rape services (this office maintains that minors under 12 can not be expected to give consent to any sexual act* and the attending physician should notify the medical office manager immediately before the minor patient leaves) and skeletal X-ray to diagnose child for abuse or neglect (the physician doesn't need either the minor's or the parent's permission in this instance) without parental permission and the physician can not inform the parents without the minor's consent. Further, minors age 12 years and older may obtain outpatient mental health services, diagnosis and/or treatment for infectious, contagious communicable disease and sexually transmitted disease, HIV/AIDS testing and treatment, rape and alcohol and drug abuse treatment without parental/guardian consent. When

Many people are unsure of the rights granted to minors because of the laws in place, or the lack of laws in place. In fact there are laws, such as the Privacy Act of 1988 that could be a reason people are confused about the rights minors have to confidentiality. This act is directly described in a professional practice article when Bird (2007), stated that an adolescent’s health information can be released to a guardian, but in circumstances where a minor is capable of making their own medical decisions, they should be allowed to do so (p. 655). Bird further explained that “If an adolescent is able to consent to their own medical treatment, then they are

There are many legal and ethical situations that healthcare providers will be faced with when providing medical treatment to either a child or an elderly adult. While there is often much discussion regarding the elderly and do not resuscitate orders, there are often times when the decisions for health care of a child may be overlooked. Some of the legal issues that may be faced by healthcare professionals are informed consent, confidentiality, reproductive services and child abuse. Patients have the right to decide what is done to their own bodies, but for children under eighteen, their parents decide for them. A major issue faced by healthcare professionals is parental refusal for treatment. Healthcare providers will be faced with many conflicting ethical and legal situations regarding refusal of a minor’s healthcare and treatment. These issues

According to Beauchamp and Childress, the principle of autonomy asserts that a capable and competent individual is free to determine, and to act in accordance with, a self-chosen plan (Beauchamp and Childress as cited in Keating and Smith, 2010). Determining a patient's competence is critical in striking a proper balance between respecting the autonomy of patients who are capable of making informed decisions and protecting those who are not fully capable (Appelbaum, 2007). Tagging children incompetent solely on the basis of their age and not involving them in decision making regarding their health is violation of children's human right. Obtaining consent from parents, rather than children, negates one of the most important principles of medical ethics, which is patient autonomy. Nurses are obligated to promote the health of children by embracing children's right. Nurses' duties which stem out of respect for autonomy include both duties to ensure children's self determination is respected and to refrain from practices that interfere with the children's right of decision making (CARNA,